I began working with patient who was very ready to talk with me about her end-of-life, although she had not yet communicated any of her thoughts to her family - especially her two daughters, even though they had a close relationship.

My initial conversations with the patient focused on helping her become clear about what she wanted her end of life to look like. We talked through the support measures she wanted and didn't want. She discussed how she wanted her burial proceedings to go. It quickly became apparent that she was very adamant that she wanted many things a specific way at the end of her life. She felt validated knowing that we could discuss such matters.

After a few sessions with her, we came back to the barriers to communicating with her daughters. I asked her what she had told them and what she believed they already knew. She told me that her living will was very clear but she wanted to share more with her daughters -- she needed to make sure they were okay with her decisions, and why she made them. Like most families, they had never really talked about this subject before.

She also wanted to leave her daughters with something they could always remember her by; She was feeling very unsettled not being able to think of something to give them. Knowing she would eventually come to the answer she needed, I sent her some glass heart mementos in the meantime, along with a note that I was thinking of.

On our next phone call, she told me that she had received the hearts and because of our conversations, she now knew what she wanted to do: She planned to write her daughters a letter and accompany it with a glass heart memento. She said that it was very important they knew she wanted them to be ok. She wanted them to have something tangible to hold onto, to make the transition easier. She would keep one heart in her pocket while she was buried and each daughter would have one of their own. As a perfect link from her to them, the hearts allowed her to find the words she couldn't before.

The most important part of this story is the value of deep and thoughtful communication at end of life. Without our conversations and the Living Well program, she would have had a living will but completely missed the opportunity to make sure nothing was left unexplained or unsaid. Our program is designed to go beyond advance care planning, so that the entire end of life process is reflective of someone's wishes and wants.

Having a meaningful conversation with her daughters was much more important than the advance directive paperwork. She knew what she wanted, but didn't know how to make sure her daughters were okay with her decisions. Vital Decisions made a difference.